Acute symptomatic seizures in patients with recurrent ischemic stroke: A multicentric study

• Published in: Epileptic disorders 2024-12, Vol.26 (6), p.787-796
• Main Authors: Leal Rato, Miguel, Schön, Miguel, Zafra, Maria Paula, Aguiar de Sousa, Diana, Pinho e Melo, Teresa, Franco, Ana Catarina, Peralta, Ana Rita, Ferreira‐Atuesta, Carolina, Mayor‐Romero, Luis Carlos, Rouhl, Rob P. W., Bentes, Carla
• Format: Article
• Language: English
• Subjects: acute symptomatic seizures; Aged; Aged, 80 and over; Convulsions & seizures; EEG; Epilepsy; Female; Functional anatomy; Humans; Infarction, Middle Cerebral Artery - complications; Infarction, Middle Cerebral Artery - physiopathology; Ischemia; Ischemic Stroke - complications; Ischemic Stroke - epidemiology; Ischemic Stroke - physiopathology; Male; Middle Aged; Recurrence; Retrospective Studies; Risk Factors; Seizures; Seizures - etiology; Seizures - physiopathology; Stroke; Structure-function relationships; vascular epilepsy
• ISSN: 1294-9361; 1950-6945; 1950-6945
• DOI: 10.1002/epd2.20279

Objective Epileptic seizures occur frequently after stroke due to changes in brain function and structure, and up to around 10% of stroke patients experience stroke recurrence in the first year. We aimed to establish the risk of acute symptomatic seizures in patients with recurrent stroke. Methods Retrospective cohort study including consecutive admissions to a Stroke Unit due to acute ischemic stroke, during a 5‐year period. Additional inclusion of patients admitted to two centers in different countries to corroborate findings (confirmatory cohort). We aimed to compare acute symptomatic seizure incidence in patients with and without previous stroke. Patients with history of epilepsy were excluded. Logistic regression modeling was performed to identify predictors in middle cerebral artery (MCA) stroke. Results We included 1473 patients (1085 with MCA stroke), of which 117 had a recurrent ischemic stroke (84 with MCA stroke). Patients with recurrent stroke had a seizure risk during hospital stay similar to that of patients with a first‐ever stroke (5.1% vs. 4.5%, OR 1.15, 95% CI .48–2.71, p = .75). Risk of acute symptomatic seizures was also similar (5.0% vs. 4.1, OR 1.22, 95% CI .29–5.27, p = .78). Older age, female sex, and hemorrhagic transformation were predictors of seizures in patients with a first MCA ischemic stroke, but not in recurrent stroke patients. Electrographic characteristics were similar between the two groups in patients who had an electroencephalogram (46 with first stroke, 5 with recurrent stroke). The low rate of seizures (1.5%) in the confirmatory cohort (n = 198) precluded full comparison with the initial cohort. Nevertheless, the rate of seizures was not higher in stroke recurrence. Significance History of previous stroke was not associated with an increased risk of acute symptomatic seizures during hospital stay. Larger, prospective studies, with prospective electrophysiological evaluation, are needed to explore the impact of stroke recurrence on seizure risk.